Background
Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS).
Objectives
This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran.
Patients and Methods
This cross-sectional study was conducted in the first six months of 2013. All the 400 patients with multiple trauma, transferred by EMS to the Shahid Beheshti Medical Center, were recruited. The study instrument was a checklist, which was completed through observation. Descriptive statistics were presented.
Results
Out of all included individuals, 301 were males (75.2%) and 99 were females (24.8%). The most common mechanism of trauma was traffic accident (87.25%). Furthermore, 71.7% of the patients were injured in head and neck and chest areas. The quality of consciousness monitoring and airway management was desirable in 95% of the cases. However, the quality of monitoring patients’ respiration was only desirable in 42% of the cases. Only 18.6% of the patients received oxygen therapy during prehospital transportation.
Conclusions
The quality of monitoring patients’ respiration and oxygen therapy was undesirable in most patients with multiple trauma. Therefore, the EMS workers should be retrained to apply proper respiration management in patients with multiple trauma.

Introduction
Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite.
Case Presentation
We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite.
Conclusions
Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.

Background
In recent decades, the incidence of spinal cord injuries has increased. In a systemic review on epidemiology of traumatic spinal cord injury in developing countries reported 25.5/million cases per year.
Objectives
To assess the quality of life (QOL) of the veterans among Iran-Iraq war with chronic spinal cord injuries (SCI) and to evaluate long-term impressions of SCI on their quality of life.
Patients and Methods
Fifty-two veterans, all male, with chronic spinal cord injury from Iran-Iraq war (1980-1988) were interviewed and examined. The mean age of veterans at the time of interview was 49.3 years (38 to 80 years). Veterans were assessed by using a 36-item short-form (SF-36), hospital anxiety and depression scale (HADS) and the Barthel index. The presence or absence of pressure sores and spasticity were documented as well.
Results
The mean age of veterans at the time of study was 49.3 years. Pearson's correlation test showed that depression and anxiety have a reverse association with mental component summary (MCS) scale and physical component summary (PCS) scale scores, respectively. Regression analysis showed a negative effect of depression and pressure sore on PCS. Moreover, no association was found between the duration of injury and age with quality of life.
Conclusions
Lower QOL was found among veterans with chronic SCI. More researches on health-related quality of life (HRQOL) are needed to give us a better understanding of changes in life of patients with SCI and the ways to improve them.

Background
Because the quality of information on the Internet is of dubious worth, many patients seek out reliable expert sources. As per the American Medical Association (AMA) and the National Institutes of Health (NIH) recommendations, readability of patient education materials should not exceed a sixth-grade reading level. The average reading skill of U.S. adults is at the eighth-grade level.
Objectives
This study evaluates whether a recognized source of expert content, the American Association for Surgery of Trauma (AAST) website’s patient education materials, recommended readability guidelines for medical information.
Materials and Methods
Using the well-validated Flesch-Kincaid formula to analyze grade level readability, we evaluated the readability of all 16 of the publicly-accessible entries within the patient education section of the AAST website.
Results
Mean ± SD grade level readability was 10.9 ± 1.8 for all the articles. All but one of the articles had a readability score above the sixth-grade level. Readability of the articles exceeded the maximum recommended level by an average of 4.9 grade levels (95% confidence interval, 4.0-5.8; P < 0.0001). Readability of the articles exceeded the eighth-grade level by an average of 2.9 grade levels (95% confidence interval, 2.0-3.8; P < 0.0001). Only one of the articles had a readability score below the eighth-grade level.
Conclusions
The AAST’s online patient education materials may be of limited utility to many patients, as the readability of the information exceeds the average reading skill level of adults in the U.S. Lack of patient comprehension represents a discrepancy that is not in accordance with the goals of the AAST’s objectives for its patient education efforts.

Background
Metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa in the burn patients is a leading cause of morbidity and mortality and remains a serious health concern among the clinicians.
Objectives
The aim of this study was to detect MBL-producing P. aeruginosa in burn patients and determine multidrug-resistant (MDR) strains, and respective resistance patterns.
Patients and Methods
In this cross-sectional study, 270 strains of P. aeruginosa were isolated from the burn patients referred to Ghotbeddin Burn Hospital, Shiraz, Iran. Among them, 55 MBL-producing P. aeruginosa strains were isolated from 55 patients hospitalized in burn unit. Minimum inhibitory concentrations (MICs) and MBLs were determined by the E-test method.
Results
Of the 55 burn cases, 29 (53%) were females and 26 (47%) males. Injured burn patients’ ages ranged from 16 to 87 years, with maximum number of cases in the age group of 16 to 36 years (n, 40; 72.7%). Overall, 32 cases were accidental (60%), and 22 were suicidal burns (40%). Of the 55 burn patients, 17 cases were expired (30%). All deaths were due to chemical exposures. In antibiotic susceptibility testing by E-test method, ceftazidime was the most effective one and 35 isolates (63.5%) were resistant to all the 11 tested antibiotics.
Conclusions
Routine microbiological surveillance and careful in vitro testing of antibiotics prior to prescription and strict adherence to hospital antibiotic policy may help to prevent, treat, and control MDR and pandrug-resistant (PDR) P. aeruginosa strains in burn units.

Background
Patients, who survived from shotgun injuries, often have some retained lead pellets in their bodies. Several cases of lead toxicity have been reported regarding these patients.
Objectives
This study seeks to compare the serum lead level in patients who have retained lead pellets in their bodies with the control group.
Patients and Methods
In this case-control study, we gathered the serum lead levels of 25 patients with some retained lead pellets in their bodies due to shotgun and 25 volunteers without similar lead exposure and compared them in view of the age, gender, and living place.
Results
While the mean serum lead level in both groups was lower than the standard level (i.e. 40 µg/dL) , the mean ± SD of serum lead level were 29 ± 12.8 µg/dL and 25.3 ± 6.4 µg/dL in the case and control groups, respectively without any significant difference (P = 0. 30) . However, a positive relationship was seen between serum lead level, and the number of retained lead pellets (r = 0.447, P = 0. 025) .
Conclusions
Although extensive surgery to remove the lead pellets is not recommended in patients injured with shotguns, those with many retained lead pellets in their bodies should be considered at risk for lead poisoning and monitored carefully.